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Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure
DSM-5 Proposed Criteria A'''. More than minimal exposure to alcohol during gestation, including prior to pregnancy recognition. Confirmation of gestational exposure to alcohol may be obtained from maternal self-report of alcohol use in pregnancy, medical or other records, or clinical observation. '''B. Impaired neurcognitive functioning as manifested by one or more of the following: # Impairment in global intellectual performance (i.e., IQ of 70 or below, or a standard score of 70 or below on a comprehensive developmental assessment). # Impairment in executive functioning (e.g., poor planning and organization; inflexibility; difficulty with behavioral inhibition). # Impairment in learning (e.g., lower academic achievement than expected for intellectual level; specific learning disability). # Memory impairment (e.g., problems remembering information learned recently; repeatedly making the same mistakes; difficulty remembering lengthy verbal instructions). # Impairment in visual-spatial reasoning (e.g., disorganization or poorly planned drawings or constructions; problems differentiating left from right). C'''. Impaired self-regulation as manifested by one or more of the following: # Impairment in mood or behavioral regulation (e.g., mood lability; negative affect or irritability; frequent behavioral outbursts). # Attention deficit (e.g., difficulty shifting attention; difficulty sustaining mental effort). # Impairment in impulse control (e.g., difficulty waiting turn; difficulty complying with rules). '''D. Impairment in adaptive functioning as manifested by two or more of the following, one of which must be (1) or (2): # Communication deficit (e.g., delayed acquisition of language; difficulty understanding spoken language). # Impairment in social communication and interaction (e.g., overly friendly with strangers; difficulty reading social cues; difficulty understanding social consequences). # Impairment in daily living skills (e.g., delayed toileting, feeding, or bathing; difficulty managing daily schedule). # Impairment in motor skills (e.g., poor fine motor development; delayed attainment of gross motor milestones or ongoing deficits in gross motor function; deficits in coordination and balance). E'''. Onset of the disorder (symptoms in Criteria B, C, and D) occurs in childhood. '''F. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning. G'''. The disorder is not better explained by the direct physiological effects associated with postnatal use of a substance (e.g., a medication, alcohol or other drugs), a general medical condition (e.g., traumatic brain injury, delirium, dementia), another known teratogen (e.g., fetal hydantoin syndrome), a genetic condition (e.g., Williams syndrome, Down syndrome, Cornelia de Lange syndrome), or environmental neglect. '''Differential Diagnosis Disorders that are attributable to the physiological effects associated with postnatal use of a substance, another medical condition, or environmental neglect Other considerations include the physiological effects of postnatal substance use, such as a medication, alcohol, or other substances; disorders due to another medical condition, such as traumatic brain injury or other neurocognitive disorders (e.g., delirium, major neurocognitive disorder [dementia]); or environment neglect. Genetic and teratogenic conditions Genetic condition such as Williams syndrome, Down syndrome, or Cornelia de Lange syndrome and other teratogenic conditions such as fetal hydantoin syndrome and maternal phenylketonuria may have similar physical and behavioral characteristics. A careful review of prenatal exposure history is needed to clarify the teratogenic agent, and an evaluation by a clinical geneticist may be needed to distinguished physical characteristics associated with these and other genetic conditions.